Table of Content

15 March 2026, Volume 29 Issue 08

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Guidelines·Consensus

Expert Consensus on Perioperative Nutritional Management for Liver Cancer Based on the Enhanced Recovery after Surgery Concept (2025)

Chinese Rehabilitation Medicine Association Community Rehabilitation Working Committee

2026, 29(08):  953-964.  DOI: 10.12114/j.issn.1007-9572.2025.0378

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Patients with hepatocellular carcinoma (HCC) frequently experience malnutrition due to impaired liver function, tumor-related cachexia, and treatment-related toxicities, which significantly increases postoperative complications and reduces survival rates. The enhanced recovery after surgery (ERAS) concept, implemented through multidisciplinary perioperative nutrition management, has been proven to shorten hospital stays and decrease complications. However, there remains a lack of specialized consensus on perioperative nutrition management for HCC patients within the ERAS framework. This consensus integrated evidence-based findings with multidisciplinary clinical experience, focusing on three core aspects: nutritional screening and assessment methods, perioperative nutrition protocols, and multidisciplinary collaboration pathways. It established a standardized nutrition management model, including dynamic perioperative nutritional status screening and assessment, staged nutritional support, exercise and psychological intervention, and precise multidisciplinary collaboration strategies. The aim was to standardize clinical practice, improve nutritional status, and enhance outcomes for HCC patients. This consensus was intended for hepatobiliary oncology departments and community hospitals, providing a scientific and personalized perioperative nutrition management plan under the ERAS concept for patients with liver cancer.

A Systematic Review of Fatigue Assessment Tools for Cancer Patients Based on the COSMIN Guidelines

ZHOU Hongmei, HE Lin, XU Hui, WANG Ning

2026, 29(08):  965-973.  DOI: 10.12114/j.issn.1007-957.2024.0523

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Background

Accurate assessment of fatigue in cancer patients is conducive to accurately identifying the severity of fatigue in cancer patients, which in turn allows for more targeted development of interventions. At present, there is a variety of fatigue tools for assessing fatigue in cancer patients both domestic and overseas, but there is lack of systematic integration of the measurement properties of such scales, which makes the selection of assessment tools for rational and standardised assessment difficult.

Objective

To evaluate the methodological quality and measurement properties of fatigue measurement tools for cancer patients.

Methods

Studies on fatigue assessment tools for cancer patients were searched in CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library and Web of Science from the time of the database construction to May 31st, 2024. These data was screened and cross-checked independently by two investigators, then the included studies were evaluated according the Consensus Criteria for the Selection of Health Measurement Tools (COSMIN) to form recommendations.

Results

A total of 22 papers were contained, including: PedsQLTMMultidimensional Fatigue Scale (PedsQLTMMFS), Chinese version PedsQLTMMFS, Functional Assessment of Cancer Therapy Fatigue Scale (FACT), Chinese version FACT (FACT-F), Multidimensional Fatigue Inventory (MFI-20), Chinese version MFI-20, Cancer-related Fatigue Scale, Cancer-related Fatigue Comprehensive Screening Scale, Self-rating Scale for Cancer-related Fatigue, Multidimensional Fatigue Symptoms Inventory (MFSI), Chinese version MFSI-Short Form (MFSI-SF), Fatigue Symptom Inventory (FSI), Daily Fatigue Cancer Scale (DFCS), The Childhood Fatigue Scale, Chinese version of the Children's Fatigue Scale (CF-C), Cancer Fatigue Scale (CFS), Chinese version of the CFS (CFS-C), Cancer Fatigue Scale (CF), Brief Fatigue Inventory (BFI), and Cancer-related Fatigue Questionnaire, Piper Fatigue Scale Revised (PFS-R), Schwartz Cancer Fatigue Scale (SCFS), totaling 22 tools for assessing cancer patient-related fatigue. As the content validity was uncertain for all scales and the quality of evidence was moderate or below, 19 scales were recommended at level B and 3 scales were recommended at level C.

Conclusion

The MFSI scale was recommended for the assessment of fatigue in cancer patients (recommendation level B), but the methodological quality and measurement properties still needed improvement.

Opportunistic Screening Strategies and Brief Help Method for General Practice Patients with Excessive Drinking Behaviour: Insights from the RACGP Guidelines for Preventive Activities

LI Anchun, HE Zhiguang, QIU Shanjiao, CHEN Zhang, HUANG Wenjing

2026, 29(08):  974-981.  DOI: 10.12114/j.issn.1007-9572.2025.0450

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Hazardous alcohol use is a major contributor to the burden of disease in China. However, in primary care settings, alcohol-related problems are often under recognized and under treated, and there is a lack of practical guidance to support general practitioners in screening for and preventing excessive drinking in routine care. This paper interprets and analyzes the latest recommendations on hazardous alcohol use from the Royal Australian College of General Practitioners (RACGP) Guidelines for preventive activities in general practice ("Red Book"), and discusses potential barriers to implementing these core recommendations in the Chinese context. We argue that, compared with universal screening, an opportunistic screening strategy triggered by clinical cues is more feasible and realistic in China. Drawing on the Red Book recommendations and considering the realities of primary care in China, we propose integrating opportunistic screening and brief interventions for excessive drinking into the public health service system (family doctor contract services). Through team based family doctor services, incentive mechanisms, and patient empowerment, the identification and management of hazardous drinkers can be embedded into the routine practice of general practitioners.

Health Services Research

Study on Quality Evaluation of Community Health Service of Patients with Multiple Chronic Diseases Based on Ratchet Effect: Taking Medical Insurance as a Moderator Variable

WANG Na, ZHAI Fangming

2026, 29(08):  982-987.  DOI: 10.12114/j.issn.1007-9572.2024.0321

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Background

Multiple chronic diseases have become an important characteristic of the development of chronic diseases, the chronic disease response method based on community health services has been recognized as one of the most cost-effective solutions, the quality of community health services affects the well-being of the public. Ratchet effect is beneficial for behavioral research, and we can provide useful reference for the evaluation of community health service quality for patients with multiple chronic diseases based on the perspective of doctor-patient behavior.

Objective

Research on the influencing factors of community health service' quality evaluation for patients with multiple chronic diseases based on ratchet effect.

Methods

Using multi-stage sampling method to select patients with multiple chronic diseases as the research subjects from 18 communities in Guangzhou, Guangdong Province, during July to August 2023. The community health service quality assessment questionnaire was used the PCAT scale developed by the Johns Hopkins Primary Care Center in the United States. Exploring the impact on the evaluation of community health service quality for patients with multiple chronic diseases under the moderation effect of medical insurance by constructing a multiple linear regression model.

Results

We included 282 subjects with 129 males and 153 females, their average age was (38.0±8.0) years old. Married accounted for the majority of the participants, with 165 (58.51%); local residents predominated, with 215 individuals (76.24%); the distribution of educational backgrounds was balanced, with postgraduates constituting the largest group: 112 individuals (39.73%); the majority of residents' monthly income were below 5 000 yuan, with 163 individuals (57.80%); a total of 242 participants (85.81%) reported their health status as good or very good; the majority of participants were covered by public healthcare, urban employee social insurance, and urban resident social insurance, with 239 individuals (84.75%). The PCAT score for patients with multiple chronic conditions was (104.47±13.63) points. Statistically significant differences (P<0.05) were observed in PCAT scores based on different monthly income levels and health statuses. There was a statistically significant difference (P<0.05) in PCAT among institutions which had two levels of familiarity with multiple chronic diseases' patients, and the same for variations in willingness to utilize primary care services. Medical insurance had a positive moderating effect on the evaluation of community health service quality for patients with multiple chronic diseases (P<0.05). The behavior indicators of doctor-patient relationship had a ratchet effect on the evaluation of community health service quality for patients with multiple chronic diseases. That is to say, the higher the familiarity of community health service institutions with patients with multiple chronic diseases and the stronger the intention of patients with multiple chronic diseases to seek medical treatment at the grassroots level, the higher the evaluation of the quality of community health services for patients with multiple chronic diseases, it showed a phenomenon of only increasing without decreasing.

Conclusion

Medical insurance can enhance the evaluation of community health service quality by patients with multiple chronic conditions. The state should continue to introduce beneficial policies for improving the patients' medical experience. At the same time, we should advocate for the establishment of effective two-way communication between doctors and patients. Furthermore, we should continue to strengthen the awareness of primary care for patients with multiple chronic diseases.

The Health-related Quality of Life of Rural Women in the Southern Mountainous Regions of Ningxia Hui Autonomous Region and Its Impact on the Utilization of Health Services

HU Qi, XU Ning, MA Ximin, HE Jiahui, QIAO Hui

2026, 29(08):  988-996.  DOI: 10.12114/j.issn.1007-9572.2023.0912

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Background

With economic development and urbanization accelerating, rural women have become the primary labor force in their families, yet their health-related quality of life (HRQOL) is not optimistic. In the southern mountainous regions of Ningxia Hui Autonomous Region, due to geographical remoteness and limited educational levels, local rural women are more prone to neglecting their own health status.

Objective

To investigate the HRQOL of rural women in the southern mountainous regions of Ningxia Hui Autonomous Region and its impact on health service utilization, providing a theoretical basis for improving rural women's quality of life and rationally allocating health resources.

Methods

From July to October 2019, a multi-stage cluster random sampling method was used to survey 4 682 women from four counties in Ningxia Hui Autonomous Region. Demographic characteristics, family characteristics, health service accessibility, health status, HRQOL, and health service utilization information were collected. HRQOL was measured using the European Quality of Life-5 Dimensions-3 Levels (EQ-5D-3L) scale. A conditional Logistic regression model was used to analyze the impact of HRQOL on health service utilization.

Results

The two-week outpatient visit rate for women in the southern mountainous regions of Ningxia Hui Autonomous Region was 12.43% (582/4 682), the one-year hospitalization rate was 22.53% (1 055/4 682), and the mean health utility value was (0.88±0.15). Among the five dimensions of the EQ-5D-3L, self-reported pain/discomfort had the greatest impact on outpatient service utilization (OR=1.797, 95%CI=1.470-2.196, P<0.05) and inpatient service utilization (OR=1.791, 95%CI=1.512-2.121, P<0.05). Multivariate Logistic regression analysis showed that, after adjusting for confounding factors, health utility values had an impact on both outpatient service utilization (OR=0.291, 95%CI=0.172-0.494, P<0.05) and inpatient service utilization (OR=0.239, 95%CI=0.146-0.391, P<0.05).

Conclusion

The quality of life of rural women in western China is not optimistic, and HRQOL is closely related to health service utilization. Therefore, it is necessary to further strengthen the construction of the primary health service system.

Article

Study on the Prediction of Muscle Attenuation in Patients with Acute Ischemic Stroke by the Cross-sectional Area and Thickness of the Temporalis Muscle

CAO Lei, LIU Xuechun, JIANG Wei, CHEN Yan, YAN Sunhong, DU Jing

2026, 29(08):  997-1007.  DOI: 10.12114/j.issn.1007-9572.2025.0364

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Background

Sarcopenia in patients with acute ischemic stroke (AIS) is significantly associated with poor clinical outcomes. Consequently, there is a growing research interest in identifying simple and practical clinical indicators to screen the high-risk population, forming a key intersection between stroke rehabilitation and clinical nutrition.

Objective

This study aimed to explore the feasibility and clinical value of temporal muscle cross-sectional area (TMA) and temporal muscle thickness (TMT) in evaluating sarcopenia in AIS patients.

Methods

A total of 531 AIS patients (347 males, 184 females) admitted to the Second Affiliated Hospital of Anhui Medical University between January 2022 and August 2025 were enrolled. Bilateral TMA and TMT were measured via cranial CT or MRI. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Independent predictors were identified using univariate and multivariate Logistic regression analyses. A prediction model was constructed and its performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results

The prevalence of sarcopenia among AIS patients was 19.96% (106/531). Based on the diagnostic criteria, patients were categorized into a sarcopenia group (n=106) and a non-sarcopenia group (n=425). Patients in the sarcopenia group had significantly lower TMA and TMT values compared to those in the non-sarcopenia group (P<0.001). Multivariate Logistic regression analysis identified age (OR=1.717, 95%CI=1.223-2.410), NIHSS score (OR=3.213, 95%CI=1.829-5.643), NRS 2002 score (OR=1.337, 95%CI=1.045-1.711), and TMA (OR=0.781, 95%CI=0.639-0.955) as independent influencing factors for sarcopenia in AIS (P<0.05). To construct and validate the sarcopenia risk prediction model, all subjects were randomly divided into a training set (n=398) and a validation set (n=133) according to 3∶1 ratio. The final model formula, based on multivariate logistic regression analysis, was Logit(P)=46.221 22+0.082 11×age+2.078 56×(NRS 2002=1)-0.144 80×TMA+18.327 80×(NIHSS=1). A nomogram was generated to predict the risk of sarcopenia. The area under the ROC curve (AUC) of the prediction model was 0.884 (95%CI=0.782-0.947) in the training set and 0.808 (95%CI=0.679-0.882) in the validation set. The calibration curve demonstrated good consistency between the predicted and actual probabilities. Furthermore, the DCA indicated that the model provided clinical net benefits across a wide range of threshold probabilities.

Conclusion

Temporal muscle measurement is an effective method for evaluating the muscle wasting status of patients with AIS. The prediction model based on age, NIHSS score, NRS 2002 score, and TMA exhibits good discriminatory performance and clinical applicability, providing a practical tool for early identification of sarcopenia in this patient population.

Association of Glycated Albumin and Glycated Hemoglobin with Aortic Valve Calcification in Moderate and Severe Valvular Heart Disease Patients

ZHANG Junyang, ZENG Yiyao, JIN Fulu, WANG Peiyu, JIANG Yufeng, ZHOU Yafeng, ZHAO Liangping

2026, 29(08):  1008-1012.  DOI: 10.12114/j.issn.1007-957.2024.0502

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Background

Aortic valve calcification (AVC) is a common aortic valve disease and a common manifestation of cardiovascular disease. Glycated albumin and glycated hemoglobin are closely related to the occurrence and development of cardiovascular diseases, but the relationship between them and AVC in patients with aortic valve disease remains unclear.

Objective

To investigate the association of glycated albumin and glycated hemoglobin with AVC.

Methods

A total of 237 patients with AVC who were hospitalized in The Second Affiliated Hospital of Soochow University and The Fourth Affiliated Hospital of Soochow University from January 2015 to January 2023 were retrospectively enrolled as research subjects, who were divided into calcification group (188 cases) and non-calcification group (49 cases) according to the CT evaluation results. Indicators such as glycated albumin, glycated hemoglobin, fasting blood glucose as well as the regular information were recorded. Multivariate Logistic regression analysis was adopted to evaluate the influencing factors of AVC. Subject operating characteristics (ROC) curve was used to evaluate the predictive value of glycated albumin and glycated hemoglobin for AVC, and calculate the area under ROC curve (AUC).

Results

Glycated albumin, glycated hemoglobin, and fasting blood glucose levels were higher in patients of the calcification group than the non-calcification group, the difference was statistically significant (P<0.05). The results of multifactorial Logistic regression analysis showed that age and fasting blood glucose were independent influencing factors for AVC (P<0.05). The results of ROC curve analysis showed that the AUC value of glycated albumin for predicting AVC was 0.620 (95%CI=0.529-0.711), with an optimal cut-off value of 15.85%, a sensitivity of 0.559 and a specificity of 0.694. Glycated hemoglobin predicted AVC with an AUC value of 0.609 (95%CI=0.522-0.696), an optimal cutoff value of 6.15%, a sensitivity of 0.431, and a specificity of 0.796.

Conclusion

Glycated albumin and glycated hemoglobin are not independent influencing factors for the development of AVC in patients with moderate and severe aortic valve disease, and they have limited predictive value for AVC occurrence in this patient population, but can serve as auxiliary reference indicators in clinical practice.

Correlation Analysis between Body Roundness Index and Obstructive Sleep Apnea and Its Predictive Value Evaluation

ZHANG Meihong, YANG Jing, ZHONG Wenqian, WANG Shuang, GENG Ying, WU Bin, LU Zhenzhang

2026, 29(08):  1013-1019.  DOI: 10.12114/j.issn.1007-9572.2025.0275

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Background

The body roundness index (BRI) is an emerging anthropometric indicator that has been increasingly associated with various cardiometabolic conditions, including hypertension and diabetes. However, its association with obstructive sleep apnea (OSA) and its potential as a predictive tool remain poorly understood.

Objective

This study aimed to investigate the association between BRI and OSA risk and to evaluate its predictive performance for OSA in adults.

Methods

A cross-sectional analysis was conducted among 638 outpatients suspected of OSA at Shenzhen University Affiliated South China Hospital between January 2024 and March 2025. All participants underwent overnight polysomnography, and OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events per hour. Anthropometric measurements—including height, weight, waist circumference, and neck circumference were collected to calculate BRI, BMI, a body shape index (ABSI), and weight-adjusted waist index (WWI). Multivariable Logistic regression models were used to assess the association between BRI and OSA after adjusting for potential confounders. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of each index, with subgroup analyses performed by sex.

Results

Of the 638 participants, 552 (86.5%) were diagnosed with OSA. The multivariable Logistic regression revealed a significant dose-response relationship between BRI and OSA risk (P_trend<0.001). After adjusting for confounding factors, the risk of OSA in the highest quartile group of BRI (Q4: >5.744) was 6.955 times (95%CI=2.960-16.344) that of the lowest group (Q1: ≤3.931). The ROC analysis demonstrated that BRI achieved an area under the curve (AUC) of 0.740 (95%CI=0.682-0.799) for OSA detection, with an optimal cut-off value of 4.199 yielding 73.4% sensitivity and 68.6% specificity. In comparison, the AUC for ABSI, WWI, and BMI were 0.633, 0.676, and 0.717, respectively. DeLong test results confirmed that BRI's AUC was greater than those of ABSI and WWI (P<0.05). In men, the AUC of BRI in diagnosing OSA was 0.774. In women, the AUC of BRI in diagnosing OSA was 0.654.

Conclusion

BRI serves as a significant influencing factor for the prevalence of OSA among Chinese adults, demonstrating good predictive efficacy. Consequently, BRI can be utilized as an economical and effective tool for the early screening of OSA.

Correlation between Anthropometric Indices and the Risk of Stroke: a Nested Case-control Study

WANG Xiaonan, RUAN Xiaonan, LIU Yang, WU Kang, QIU Hua, LIU Qingping, SONG Jiahui, GAO Jiaojiao, ZHOU Yi, LIU Xiaolin

2026, 29(08):  1020-1028.  DOI: 10.12114/j.issn.1007-9572.2025.0178

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Background

With the socioeconomic development in China, the prevalence of overweight/obesity has risen significantly, becoming a major public health issue. Currently, commonly used obesity indicators, such as BMI and waist circumference (WC) cannot differentiate between subcutaneous fat and visceral fat, while visceral fat is closely associated to chronic diseases. Therefore, exploring the correlation between novel anthropometric indices and stroke risk holds significant importance.

Objective

To explore the correlation of different anthropometric indices with the incidence of stroke, and their predictive capacity for the risk of stroke, aiming to provide evidence for community-based chronic disease health management and cardiovascular/cerebrovascular disease surveillance.

Methods

Based on the Pudong New Area Chronic Disease and Risk Factors Surveillance Cohort Study Project, a nested case-control study was performed involving participants enrolled in the 2016 and 2019 field surveys. They were followed up until December 31, 2023. Individuals who developed stroke during follow-up were assigned to the case group, and those without developing stroke were served as controls. Data on demographics, medical history, family history, and major risk factors were collected using standardized epidemiological questionnaires. Physical and laboratory examination indicators were recorded. Logistic regression and restricted cubic spline (RCS) regression models were applied to analyze the correlation between anthropometric indices and stroke. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance, with pairwise comparisons conducted via DeLong's test.

Results

Among the 15 440 study subjects included in the analysis, a total of 930 had strokes. For every one-unit increase in BMI, WC, body roundness index (BRI), and Chinese visceral adiposity index (CVAI), the risk of stroke increased by 3.8% (OR=1.038, 95%CI=1.017-1.058), 1.2% (OR=1.012, 95%CI=1.004-1.020), 10.6% (OR=1.106, 95%CI=1.042-1.174), and 0.5% (OR=1.005, 95%CI=1.003-1.007), respectively (P<0.05). The RCS regression model showed a linear dose-response correlation of BMI, WC, and BRI with the risk of stroke (P_total<0.05, P_non-linear >0.05), and a non-linear dose-response relationship between CVAI and the risk of stroke (P_total<0.001, P_non-linear=0.009). The ROC curve results indicated that the predictive ability of CVAI for the risk of stroke (area under the curve=0.66) was better than that of BMI (Z=-12.713, P<0.001), WC (Z=-13.512, P<0.001), and BRI (Z=-8.696, P<0.001).

Conclusion

BMI, WC, BRI, and CVAI are correlated with the risk of stroke. CVAI is superior to BMI, WC, and BRI in predicting the risk of stroke and can be used as an applicable indicator for the risk of stroke. These findings underscore the need for comprehensive chronic disease management in community health programs, emphasizing weight control and the impact of visceral obesity.

Study on Healthy Dietary Recommendation Model for Inflammatory Bowel Disease Patients Based on Multi-objective Planning

YIN Tingting, TU Wenjing, BAI Yamei, HUANG Lina, LI Yiting, XU Guihua

2026, 29(08):  1029-1036.  DOI: 10.12114/j.issn.1007-9572.2024.0473

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Background

Diet is a critical component of health management for patients with inflammatory bowel disease (IBD), and modeling healthy dietary recommendations can help provide patients with tools to aid in dietary management and disease recovery.

Objective

To construct and validate a healthy dietary recommendation model for adult patients with IBD.

Methods

A research group was set up in September 2023 to clarify the recommended nutrient groups and intakes for IBD patients using literature research and Delphi expert consultation method, then screen nutrients with anti-inflammatory or pro-inflammatory properties, and identify patients' dietary preferences using food-frequency matrix method, finally establish a model for recommending healthy diets to patients with IBD using multi-objective optimization algorithms and collaborative filtering algorithm. Using purposive sampling and maximum variation sampling, 20 IBD adult patients were selected from a tertiary hospital in Nanjing in December 2023, and the model was applied to recommend personalized dietary types and intake for IBD patients using a multi-objective particle swarm algorithm and collaborative filtering algorithm to validate the model's feasibility and scientificity.

Results

The model of healthy dietary recommendations for IBD adult patients needs to meet the three main goals of nutritional needs, complementary therapies and dietary preferences at the same time. Nutritional requirements are mainly considered in six indicators: energy, protein, dietary fiber, vitamin D, calcium and iron; adjuvant therapy is based on the comprehensive consideration of seven anti-inflammatory nutrients such as dietary fiber, vitamin A, vitamin C, vitamin E, selenium, magnesium and zinc, as well as the four major pro-inflammatory nutrients such as energy, fat, protein and iron; and algorithmic solving results in a personalized dietary recommendation plan in line with the dietary preferences of the 20 patients with IBD. The validation results showed that the average accuracy of the model's food group recommendations was 95.5%, and the average nutrient error was 12.60%.

Conclusion

The model of healthy dietary recommendations for IBD adult patients constructed in this study is accurate and effective and helps to improve the refinement of IBD dietary management.

Article·Cognitive Impairment Section

Advances in Community Screening and Diagnostic Management Strategies for Individuals with Mild Cognitive Impairment

WANG Chenyu, WANG Xiaoyan, ZHANG Lixiu, WANG Lina

2026, 29(08):  1037-1043.  DOI: 10.12114/j.issn.1007-9572.2023.0356

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Community screening and diagnosis of mild cognitive impairment (MCI) in the community are of great value in the prevention of dementia. Currently, there is still no consensus on the management of community screening and diagnosis in the MCI population. This study conducted a detailed review of the current management of community screening and diagnosis, specific items for screening and diagnosis, and peri-diagnostic support for the MCI population, and found that community screening and diagnosis of MCI need to be comprehensively assessed in terms of population definition, history taking, cognitive assessment and auxiliary testing; peri-diagnostic support should include post-diagnostic disclosure, development of post-diagnostic support program and guidance on post-diagnostic support. Thus, it is suggested that community healthcare workers should carry out comprehensive assessment and diagnosis of the MCI population, and actively carry out rapid post-diagnostic support actions to promote the dementia prevention to be really moved forward.

Construction of the Evaluation System of Cognitive Impairment Screening Service in the Community Based on RE-AIM Framework

PANG Ting, LI Wanxin, ZHANG Haoran, LIN Zhiying, XU Xin

2026, 29(08):  1044-1050.  DOI: 10.12114/j.issn.1007-9572.2024.0426

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Background

China has now launched the Alzheimer's disease prevention and treatment promotion action, and local communities are actively carrying out cognitive function screening around the community elderly population. However, there is no suitable evaluation standard to be used as the basis for the screening of cognitive impairment in the community.

Objective

To construct an evaluation system for cognitive impairment screening services applicable to the community, and to provide a reference for the appraisal and quality control of large-scale community-based cognitive function screening programs among older adults in various regions of China.

Methods

By literature research and policy analysis, the first draft of the indicator system was proposed around the five elements of the RE-AIM framework, and 15 experts were selected to carry out a Delphi expert consultation to construct an evaluation indicator system for community-based cognitive impairment screening services from October 2023 to January 2024. The weights of the indicators were determined using the multiplier method.

Results

The positive coefficients of experts in the two rounds of Delphi were 100.0% and 93.3%, the experts' authority coefficients were 0.83 and 0.86, and the coordination coefficients of experts' opinions were 0.242 and 0.265 (P<0.001), and the final evaluation system consisted of 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators. The first-level indicators and their weights were screening reachability (0.203 5), screening efficacy (0.203 5), program adoption by the organization (0.194 8), program implementation (0.203 5), and program maintenance (0.194 8).

Conclusion

The evaluation index system of the community cognitive impairment screening service initially constructed in this study, which contains 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators, is of good scientific validity and reliability, and has certain reference value for improving the assessment system of cognitive impairment screening.

Concept Analysis and Implementation Framework of Dementia Day Care Service

LI Xianwen, LI Xinru, LIU Haining, YIN Yueheng, SHAN Enfang, DING Yaping, NIU Shuzhen, XING Ying

2026, 29(08):  1051-1056.  DOI: 10.12114/j.issn.1007-9572.2023.0883

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Day care service is an important component of the community care service system for elderly people with dementia. However, the concept of dementia day care has not been unified, and its connotation and implementation framework have not been clarified, which greatly affects the continuous construction and high-quality service supply of dementia day care service. The Walker classic concept analysis method was used and five attributes of the concept was introduced including (1) daytime intensive, non-residential care; (2) professional coordination and integrated care focused on families with dementia; (3) public respite care support for families with dementia; (4) a crucial complement to high-quality care for dementia; (5) a driving force in promoting a dementia-friendly community. The preconditions of dementia day care include high care needs, weakened family functions and the dominant role of public care, and the consequences involve dementia, family caregivers and social welfare. The implementation factors identification, implementation strategy design, implementation and effect evaluation were carried out respectively using the consolidated framework for implementation research, the replicating effective programs implementation framework and the RE-AIM evaluation framework in the field of implementation science. The specialization, high quality, integrated care, and the philosophy of the friendly community should be highlighted in the future development of dementia day care. The service content, facilities and implementation process need to be improved to promote the quality of dementia day care service.

Article·Drug Use Guide

Evidence-based Pharmacological Investigation of the Clinical Practice and Rational Use of Metformin in Pre-diabetes Mellitus

LIU Dianchun, CHEN Xiaoying, WANG Qianyun, PAN Xingru, WEI Xuehan, WANG Bohong, WANG Ying, XUE Xue, LU Chunli

2026, 29(08):  1057-1068.  DOI: 10.12114/j.issn.1007-9572.2024.0579

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Prediabetes is a condition where blood glucose levels have deviated from the normal range but have not yet reached the diagnostic criteria for diabetes. It represents a transitional phase between health and diabetes. Currently, there are no global guidelines for managing prediabetes. However, the use of metformin in prediabetes is largely based on clinical experience, and there is a lack of high-quality evidence-based medicine. There are uncertainties regarding its dosage and unknown adverse reactions, and its exact efficacy and safety still require further study. This article systematically reviews the current state of metformin in the treatment of prediabetic, analyzing differences in efficacy across different dosages, the guideline recommendations, clinical application experiences, potential adverse effects and irrational drug use. We aim to provide scientific basis and clinical practice guidance for the rational use of metformin in the management of prediabetes.

The Disease Burden of Drug Use Disorders in the Chinese Population from 1990 to 2021 and Trend Predictions from 2022 to 2046

ZHANG Ziyu, HAN Shukui, MA Xin, SONG Panpan, MA Jinxiang, REN Yitao, CHEN Hongru

2026, 29(08):  1069-1076.  DOI: 10.12114/j.issn.1007-9572.2024.0719

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Background

Drug use disorders have become a major global public health challenge, threatening people's health, increasing the disease burden and hindering economic development and social progress. As the burden of disease varies among different drugs, preventing and controlling them has become a major concern for all sectors of society.

Objective

To analyse the trend in the disease burden of drug use disorders in China between 1990 and 2021. This includes calculating the age-standardised incidence and DALY rates of drug use disorders and their five subcategories, and making predictions about the incidence and DALY rates from 2022 to 2046. These findings will provide a scientific basis for policy formulation and intervention implementation.

Methods

Data from the Global Burden of Diseases 2021 (GBD 2021) database was extracted, including age-standardised incidence rates, disability-adjusted life years (DALY) rates for drug use disorders and five subcategories from 1990 to 2021 (Opioid use disorders, Cannabis use disorders, Cocaine use disorders, Amphetamine use disorders and Other drug use disorders). Joinpoint regression models were used to analyse the age-standardised incidence rates and the annual percent change(APC) and average annual percent change(AAPC) in DALY rates. Bayesian age-period-cohort prediction models were used to predict trends in age-standardised incidence and DALY rates from 2022 to 2046.

Results

Joinpoint regression analysis revealed an overall downward trend in the age-standardised incidence and DALY rates of drug use disorders in the Chinese population from 1990 to 2021 (AAPC values of -0.76% and -2.75%, respectively, both P<0.05). The age-standardised incidence and DALY rates of drug use disorders showed an overall downward trend for both males and females (AAPC values of -0.69% and -2.50% for males, and -0.85% and -3.09% for females, respectively; both P<0.05). Among the five subcategories of drug use disorders nationwide, the age-standardised incidence and DALY rates of cannabis use disorders showed an overall increasing trend (AAPC=0.66%, 0.71%, respectively; both P<0.05). The age-standardised incidence and DALY rates of the remaining four subcategories showed an overall decreasing trend (Opioids: AAPC=-1.97%, -3.41%; Amphetamines: AAPC=-1.50%, -1.66%; Cocaine: AAPC=-0.66%, -2.12%; Other: AAPC=-0.64%, -3.83%; all P<0.05). The Bayesian age-period-cohort prediction models predicted that from 2022 to 2046, the incidence and DALY rates of drug use disorders in both male and female populations in China would increase. The projected increase in incidence was approximately 50.80% for males and 24.27% for females, with a higher increase in males than females. The projected increase in DALY rates was approximately 48.34% for males and 41.46% for females, with a higher increase in males than females.

Conclusion

From 1990 to 2021, the disease burden of drug use disorders in China decreased, with males bearing a higher burden than females. With the exception of Cannabis use disorders, the remaining four subcategories of drug use disorders showed an overall downward trend. The burden due to Opioid use disorders was the most severe. However, it is projected that, from 2022 to 2046, age-standardised incidence and DALY rates will increase.

Study on Signal Mining and Influencing Factors of Adverse Events of Blinatumomab from 2014 to 2024

LIU Jinglin, ZHANG Jie, SONG Xiaokun, LI Bole

2026, 29(08):  1077-1088.  DOI: 10.12114/j.issn.1007-9572.2025.0242

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Background

Blinatumomab, as the first bispecific antibody targeting CD19, has shown significant efficacy in the treatment of acute lymphoblastic leukemia and has been widely used in clinical practice since its launch in 2014. However, the characteristics of adverse events, the differences in medication safety among different populations and the influencing factors of this drug in the real world are not very clear, requiring in-depth exploration.

Objective

To utilize the FDA Adverse Event Reporting System (FAERS) to obtain adverse drug event (ADE) reports for blinatumomab over the decade since its market launch and to analyze the influencing factors on the real-world safety of blinatumomab, thereby strengthening pharmacovigilance for high-risk populations.

Methods

Data in the FAERS database from the fourth quarter of 2014 to the third quarter of 2024 were searched. ADE positive signals were systematically classified. Conduct a statistical analysis on six types of adverse events with high incidence, strong characteristics and high relevance, including the nervous system disorders, cytokine release syndrome (CRS), immune system disorders, blood and lymphatic system disorders, infections and infestations, lineage switch leukaemia, categorized by various influencing factors such as age, gender, weight, interval time, and the continent where the patients were locate.

Results

A total of 18 728 cases of ADE reports for blinatumomab were collected, along with 6 961 demographic data, identifying 371 valid signals involving 20 system organ classifications (SOC). Among these, the preferred term (PT) with the highest signal strength was lineage switch leukemia, which was not mentioned in the instructions, and the most frequent SOC was nervous system disorders. Statistical differences were observed in gender, body weight, interval time, and continent of residence among minors, young and middle-aged adults, and elderly individuals who experienced adverse events (P<0.05). Statistical differences were also found in interval time and continent of residence when comparing patients with nervous system disorders to other adverse events (P<0.05), as well as for cytokine release syndrome compared to other adverse events (P<0.05). For immune system adverse events, statistical differences were noted in age and continent of residence compared to other systemic adverse events (P<0.05). Additionally, statistical differences in interval time and continent of residence were found for blood and lymphatic system disorders compared to other adverse events (P<0.05), as well as for infections and infestations compared to other adverse events (P<0.05).

Conclusion

In clinical use of blinatumomab, there should be a high level of attention to the drug tolerance of the Asian population and vigilance against immediate and delayed adverse events. Blinatumomab has been on the market in China for a short time, and there is insufficient experience in medication use. In clinical applications, it is necessary to strengthen drug surveillance and risk protection for minors and the elderly in China.